POS1345 PAIN OVER 5 YEARS IN OUR EARLY RHEUMATOID ARTHRITIS UCLOUVAIN BRUSSELS COHORT: RESULTS AND CORRELATION WITH CLINICAL RESPONSE, QUALITY OF LIFE
Authors: C. Desmet, E. Sapart, M. Lauras, B. Joly, T. Cayrol, T. Sokolova, A. Avramovska, P. Durez
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Pain is a major patient reported outcome in early rheumatoid patients (ERA). Pain is associated with disease activity but could be also related to non-inflammatory conditions. Chronic pain has a negative impact on quality of life in ERA patients. The main treatment objective in ERA is remission or low disease control, but relief of pain is a priority of patient. <h3>Objectives</h3> To evaluate the pain course and the proportion of unacceptable pain (VASp &gt;4) during a five-years follow-up in ERA patients and to investigate correlation with clinical response and quality of life. <h3>Methods</h3> 474 ERA patients fulfilling the 2010 EULAR/ACR criteria included in our ERA UCLouvain Brussels cohort were retrospectively analyzed. All were naïve to csDMARDs (MTX), b- or tsDMARDs with symptoms duration &lt; 12 months. Pain was assessed using a visual analogue scale (0-100 mm) and unacceptable pain was defined as a VAS pain &gt; 40mm (VASp&gt;4) based on the patient acceptable symptom state. VASp, HAQ and DAS28-CRP scores were assessed at baseline (BL), 6, 12, 36 and 60 months in order to correlate the % of ERA with an unacceptable pain (VASp&gt;4), non clinical response (DAS28-CRP&gt; 3.2) and no restored quality of life (HAQ &gt;0.5). <h3>Results</h3> Data from 474 eligible ERA patients were collected. The average age of the population is 48.5 years, and the BMI is 25.3. 70.5% of the patients are women. 27.1% are smokers and 68.8% are positive for anti-citrullinated protein antibody (ACPA). The evolution of VAS pain over 5 years of follow-up is shown in Figure 1: At BL, the mean VAS pain at the baseline was at 60.2 +/- 26.5mm (range 0-100mm). VASp pain was reduced by 45% (mean 33.1+/- 28.5 mm) at 6 months and remained stable with 51,7% reduction (mean 29.0 +/-27.6mm) at 5 years. 78% of patients (n=308) reported an unacceptable pain at diagnosis which was reduced to 40.4% (n=163) at 6 months and 33% at year 5 (Figure 2): No statistical difference was observed for age, sex ratio, BMI, ACPA, or RF except for smokers (27.3% vs 15.6%) between patients with unacceptable pain or not. A strong correlation was observed between the decrease of VAS pain, DAS28-CRP and HAQ at all-time points. Among the patients with an unacceptable pain at 6 months, HAQ BL score was statistically higher (1.30 +/- 0.69 vs 1.15 +/- 0.67), while the BL DAS28-CRP scores were similar (4.66 +/- 1.41 vs 4.67 +/-1.24). We identified also 20 patients with unacceptable pain throughout the 5 years follow-up, BL DAS28-CRP and HAQ values were statistically increased (5.4 +/- 1.1 vs 4.7 +/- 1.4 and 1.41 +/- 0.86 vs 1.21 +/- 0.62). By contrast, 31 patients reached a complete response defined by a VAS pain &lt;4 + DAS28-CRP&lt;3.2 + HAQ&lt; 0.5 throughout the 5 years follow up). Baseline VAS pain, DAS28-CRP and the HAQ scores assessed at diagnosis were statistically lower in this group. (38.9 +/- 28.4 vs 61.9 +/- 25.7, 4.3 +/- 1.1 vs 4.8 +/- 1.4 and 0.86 +/- 0.60 vs 1.2 +/- 0.71). All patients were treated according the standard of care, mainly with Methotrexate. <h3>Conclusion</h3> We demonstrate that control of pain is achieved in a majority of ERA patient in our cohort. Decrease of pain was correlated with decrease of the disease activity score, meaning that the positive effect is mainly related to inflammation in ERA. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.